Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT28572 | FL |
NPI | 1003242488 |
---|---|
Provider Name | Jacqueline P Palange |
First Address | Blairsville, PA 15717-8096 |
Second Address | Bradford, PA 16701-3101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2013 |
Last Update Date | 16/02/2016 |